To pay or not to pay: a question of good health

One of the more recent changes outside the parking lot of Nanaimo Regional General Hospital is the addition of a lot reserved exclusively for patients and visitors. Issues tied to the enforcement

The walk from the parking lot to the front door of your hospital is not a long trek.

It might take about two minutes, or maybe a couple hundred strides by an adult walking with purpose — more for those feeling the weight of age, illness or worry.

It’s the latter some say shouldn’t have to feel the additional burden of fretting about feeding the parking meter.

Complaints about overcrowding and aggressive ticketing in the hospital parking lot are not uncommon in Nanaimo, and underlying those complaints is a basic philosophical question faced by all public health facilities: why should people have to pay at all?

The issue has surfaced with a vengeance recently in the Campbell River area, where free hospital parking is poised to become a thing of the past when the community’s new $274.5 million, 95-bed hospital opens in late 2017.

Brenda Leigh is the elected Strathcona Regional District director for Oyster Bay/Buttle Lake, a rural area southwest of the city. Her board is unanimously opposed to pay parking at not only the new Campbell River facility, but its $331.7 million, 153-bed sister hospital, simultaneously being built in the Comox Valley.

She said her concerns apply throughout the Island Health region.

Distance is a factor for residents of many smaller communities, particularly the offshore islands. Poverty makes the ability to pay a problem. Vancouver Island’s abundance of seniors is another issue. And Leigh thinks there is something fundamentally wrong with residents having to pay to use parking stalls their tax dollars have already paid to build.

“I think it does create a barrier,” Leigh said. “It’s not a healthy idea (for) people already under a lot of stress to face the issue of paying for parking.”

Health officials aren’t fond of people calling parking fees a cash cow, not when revenues total just under $7.5 million in an organization that operates with a $2.2 billion budget. Fees — typically between $2.25 and $2.75 for the first two hours, and $1.25 for each additional hour — have not increased since 2010.

The lots at Royal Jubilee and Victoria General in Victoria are the biggest revenue generators, with the Aberdeen, Gorge Road, Saanich Peninsula, Nanaimo and Priory facilities also charging fees.

James Hanson, the Island Health corporate director of logistics and operations, points to Nanaimo Regional General Hospital as a good example of how that revenue is put to use. The parking lot at NRGH collects a little over $1.1 million in fee revenue a year, which has helped create between 120 and 140 new stalls.

According to Hanson, the fees are necessary in order to provide parking services since Island Health will always pick health care over parking when it comes to setting budget priorities.

“If we didn’t have parking fees, we would have to take it out of patient care money,” he said. “It’s that simple.”

According to Island Health, the revenue collected from parking fees also pays for all parking lot maintenance, including cleaning catch basins, oil interceptors, potholes/infrastructure repairs, lighting, line painting, snow removal, de-icing and security.

Hanson said in some ways Island Health is paying the price for its own success in reaching more patients. Hospital parking lots are starting to resemble those at the malls in terms of the amount of people coming and going.

“Surgeries that used to take three, four or five hours now take 45 minutes,” he said. “The more vehicles, the more maintenance and servicing you have to do.”

Major Island hospitals currently without parking fees include Duncan, Port Alberni and Campbell River, however users should expect that to change as aging facilities are replaced.

Leigh is skeptical of Island Health’s position that parking fees help subsidize health care, citing a 2013 Marketplace investigation which revealed that is not necessarily the case in some parts of Canada.

According to Hanson however, your parking fees are not being used to line corporate pockets. A contractor (currently Robbins) is paid a flat fee to operate and maintain the lots.

“The health authority retains parking revenue,” he said.

Public opinion is varied on the issue.

Linda Thomas works at Nanaimo hospital as an educator. NRGH employees pay between $114 and $466 annually for parking. That doesn’t bother her at all.

“In Vancouver it was $120 a month,” she said. “Coming from Vancouver that was just bonus.”

While she thinks low-income users should be subsidized, she feels parking fees are a reality others need to accept.

“It’s sort of changing for Nanaimo. It’s a growing community. I don’t have a problem. To me, it’s a nominal amount.”

As a nursing student doing her practicum at Nanaimo hospital, Ashley Lambie also has to pay a staff fee to park on site. It’s a fee she now avoids by parking off site and walking the rest of the way.

“I can’t afford the parking, but even if I could, I can’t find a parking spot,” she said.

Cars belonging to patients and visitors speckle the streets around NRGH, a situation Comox Valley officials are concerned will be repeated in the lots surrounding their new hospital.

That raises the question of off-site enforcement and municipalities having to pay for it.

But 12 years of parking at NRGH on a regular basis have given Brian Evans a different perspective.

As an Anglican minister who gets free volunteer parking for his pastoral care work, Evans said he has seen great improvement in Nanaimo, including new lots and designated patient and visitor parking areas.

“Parking is so expensive to provide,” he said. “People have to realize there is a cost for this service.”

“I remember living in small-town Saskatchewan. When we had to pay for parking we thought it was the end of the world. It wasn’t long before we forgot.”

Evans said for every person complaining about a ticket for going ten minutes over the limit, there is someone else who got away with an extra half-hour.

“If going in you figure it’s two hours, you better plan for four. That’s the reality of going to the hospital.”

Several sources who declined to be interviewed on the record for this story termed Nanaimo’s enforcement officials “parking Nazis.” Lambie didn’t use those words, but she has learned the lesson first-hand.

“They are very efficient. I’ve gotten several tickets,” Lambie said. “I understand that it’s their job, but there is no leeway at all.”

According to Wilson, Island Health receives few complaints about overcrowding or aggressive ticketing at the Nanaimo site.

But for Andy Webster, those issues take a back seat to affordability.

Even if long-term parking fees may only amount to $10 or $15 a day (weekly permits are available for $26.75), Webster says for some people that’s $10 or $15 they don’t have, especially when hospital visits become extended.

“It does (matter) if you have a relative in intensive or long-term care,” he said. “It is only through the charity of family that they can get by.”

A resident of Victoria, Webster was at NRGH visiting a relative from Ahousat.

“Ahousat is already marginalized. It’s not just Ahousat. I’m sure there are people in Nanaimo who are marginalized.”

Several people pointed to subsidies as a means of addressing that issue. They may be surprised to discover some are already in place.

Renal patients requiring life-sustaining dialysis are issued a permit and provided parking areas. Family members and caregivers of residents in long-term care facilities are not charged either.

“We also have hardship provisions to waive or reduce parking fees where they will pose a genuine challenge to families – and we can substantially reduce rates for patients facing an extended stay through purchase of a weekly parking rate permit that is valid 24/7,” Wilson said.

Hanson said that anyone who thinks they need a subsidy should ask on-site.

For others however, such subsidies aren’t enough. They point to the Canadian health philosophy of free and equal access for all.

People with this point of view have some support from the medical profession.

The Canadian Medical Association Journal ran an editorial in 2011 calling parking charges a user fee in disguise, and an impediment to good care.

Author Dr. Rajendra Kale told the Charlottetown Guardian the fees distracted patients, and interfered with the examination process. He said health authorities in Wales and Scotland eliminated the fees in 2008 and suggested they run counter to the Canada Health Act.

While he understands the philosophy behind that point of view, Hanson said it fails to pass the test in a pragmatic world, where, even with fees, Island Health struggles to keep up with parking demand.

“If I wasn’t in the business and knowing what it would cost, I would feel the same way,” he said. “(But) if we didn’t have paid parking, we wouldn’t have parking spaces.

“When we don’t have enough stalls, it impacts the patient experience.”

The last word on the issue belongs to B.C. Health Minister Terry Lake. Where he stands was spelled out in a recent letter to the Strathcona Regional District board:

“Because Campbell River Hospital has been a non-paying site to date, maintenance and other costs associated with the parking facilities have been born out of general health authority funding which can now be better directed toward patient care,” he wrote.

Still, Leigh and her supporters are not giving up the fight.

“We’re not accepting that,” she said. “In 15 months there will be an election, so we will see.”